About 700 Cleveland Clinic employees have opted for early retirement as the healthcare system looks to trim about $330 million from its budget.

The 700 voluntary buy-outs are not the only jobs lost as part of cuts to the Cleveland Clinic's 2014 budget. About 500 open positions will not be filled, and about 200 people have been laid-off out right.

"60 percent of our costs are labor and so we knew at some point there would be a reduction in our workforce, we just didn't know at the time last Fall how many that would be,"
says Eileen Sheil, head of corporate communications for the Cleveland Clinic.

Sheil says the job cuts are coming from hospitals and departments across the system, and are the result of changes in the healthcare industry - including the Affordable Care Act - that are pushing providers to operate much more efficiently.

"We know hospitals are going to be reimbursed a lot less than they have been previously by both private insurance and government insurance, so hospitals across the U.S.--this is not unique to Cleveland Clinic--they're preparing for the new normal," Sheil says.

At about 43,000 employees, the clinic is the region's largest employer.